Behind The Walls

The one-story building is tucked off a busy road in a residential area of Annandale about 12 miles from downtown Washington, D.C. Most people don't notice it as they pass by to a nearby church, grocery store, or restaurant, and that's the way it was intended.

You can drive up to the building, but getting inside is another matter. Outside, there's an electronic keypad, with the combination changed at random intervals. Once inside, visitors are faced with another secured door and another electronic keypad. Only if the current correct combination is entered both times can a visitor enter.

An entering visitor first notices the smell. It's not distinct--not clearly feces, not clearly body odor, not clearly cleaning liquid. But it's a sour, pervasive scent. The air itself is warm and moist. The next thing a visitor may notice are the cries in the distance: "Let me out of here." "I want to go home."

Security here is two-way. Those inside need to know the combination to exit, and none does. They're here for life. All but the front entrance is also surrounded by a tall security fence. The only telephones inside are under the control of security personnel. The meals are nutritionally adequate, but tasteless. They're usually accompanied by a small cupful of pills. Some behind the walls try to hide the pills, either in their hands, or in their mouths. But the security personnel are experienced in searching the hands and mouths for the secreted pills.

Each room has a bed and a dresser. Each also has a window and a toilet and sink. But they don't have baths or showers. Those are down the hall, and used only with supervision.

What is this place? A prison, perhaps? Well, maybe, in a manner of speaking. It's an "assisted living facility." Specifically, a facility for those with Alzheimer's. Oddly, though, many of those behind the locked doors don't seem to be declining mentally. Bring a soda to one and she remembers it for months. She'll tell you about her home nearby, and how she raised her family there. Talk to another one at dinner and she'll tell you about her service in World War II, and what her children and grandchildren are doing now. Now, it's true that most probably are better off with "assisted living." Some have difficulty dressing or bathing themselves. Most probably wouldn't remember to take their pills. Few of them would be able to drive safely.

But they didn't anticipate spending their final years in a prison. Ask them.

Some ended up here after "successful" extreme medical interventions that saved their lives. Others continue living here with such medical interventions occurring periodically.

And understand: This is a good facility. Good in that the residents aren't mistreated. Good in that the residents aren't uniformly drugged into a near comatose condition, making it far easier for the attendants to manage them. Good in that the attendants all speak English, though for most it's their second or third language. But "good" costs money--roughly $6,500 a month, plus some extras. Sometimes it's paid for by long term care insurance. Sometimes by the resident's assets. Sometimes by the children or relatives.

And here we're talking about assisted living facilities. Not nursing homes. That's another matter--one that deserves its own discussion.

But the issue here isn't one of cost. It's quality of life. It's respect for individual dignity. And it's respect for the wishes and desires of those who must face difficult decisions about their remaining years.

Ask yourself whether that's how you'd like to spend your remaining years. There's no correct answer. For some, it'll be "yes." For others, it'll be "no." For some, it'll be "I'll cross that bridge when I come to it."

Then visit one or more of these facilities. Talk with the residents. Listen to what they say.

In today's health care debate, there's no shortage of so-called and often self-proclaimed "experts" speaking for others. Granted: There are enormous complexities surrounding the health care debate, as well as many philosophical chasms. But when it comes to the elderly and how they wish to spend their final years--and even their definition of "final years"--those chasms shrink and those complexities simplify. Just talk with them. Then listen.